Prospective Epidemiological Study Research Articles

Understanding the transdiagnostic mechanisms underlying emerging psychopathology in adolescence: study protocol of a 1-year prospective epidemiological (EMERGE) study

IntroductionAdolescent mental health is a global public health challenge as most cases remain undetected and untreated, and consequently, have a high likelihood of persistence or recurrence. It is critical to...

Comparison of diet quality indices for predicting metabolic syndrome in Iran: cross-sectional findings from the persian cohort study

BackgroundThe metabolic syndrome (MetS) comprises metabolic irregularities, including hypertension and central obesity, which are influenced by genetic, metabolic, environmental, and dietary factors. As diet and lifestyle are risk factors for MetS, it is important to know which diet quality index better predicts MetS. The aim of this study is to compare the ability of different diet quality indices in predicting MetS and to identify the most effective one.MethodsThis cross-sectional study involved 5,206 participants aged 35 to 70 engaged in the Prospective Epidemiological Research Study in Iran (PERSIAN) cohort. Assessment of one year’s food intake via a validated 134-item semi-quantitative food frequency questionnaire (FFQ) facilitated the calculation of adherence to five diet quality indices: Dietary Approaches to Stop Hypertension (DASH), Mediterranean, Mediterranean-DASH Intervention for Neurodegenerative Delay (MIND), Dietary Inflammatory Index (DII), and Diet Quality Indices (DQI). While bivariate Pearson correlation and binary logistic regression aided in identifying the strongest correlation and predictor for MetS among the indices.ResultsThis study showed a significant association between adhering to the DASH diet score, Mediterranean diet score, MIND diet score, DII score, and DQI score, and the odds of developing MetS (OR: 0.94, (95% CI: 0.93–0.95), OR: 0.85, (95% CI: 0.81–0.89), OR: 0.84, (95% CI: 0.80–0.89), OR: 1.22, (95%CI: 1.11–1.34), OR: 0.95, (95%CI 0.94–0.96) respectively). Therefore, with each unit increase in DASH diet score, Mediterranean diet score, MIND diet score, DII score, and DQI score, the odds of MetS was reduced by 5.4%, 14.5%, 15.6%, 22%, 5%, respectively. All the indices were correlated with the intake of most of the micronutrients, with the strongest correlations being observed in the DII. DASH diet score aligned with the most favourable MetS biomarker risk, while DII score primarily associated with MetS and could be considered as a predictor for MetS.ConclusionThe present study’s findings reveal that between all these five diet quality indices, the DASH diet score correlates strongly with a favourable biomarker risk profile, while the DII score is predominantly linked to MetS.

Assessment of the economic benefit of smoking cessation in cancer patients

Introduction. In 2021, the results of the first large-scale prospective cohort study were published showing the negative impact of post-diagnosis smoking on the prognosis of non-small cell lung cancer (I-IIIа). The purpose of the study is to assess the possible benefits of postdiagnosis smoking cessation of patients with non-small cell lung cancer (NSLC) stage I–IIIa to both the health care system society as a whole. Materials and methods. A mathematical model (calculator) has been developed to calculate the economic benefits of smoking cessation among patients with a confirmed diagnosis of NSCLC (I–IIIa). The calculator uses indicators characterizing the postdiagnosis smoking status of patients with stage I–IIIa NSCLC, the probability of disease progression and survival in the groups of those who continue to smoke and those who quit smoking. These data were obtained from the prospective epidemiologic study performed in the department of clinical epidemiology, N. N. Blokhin NMRC of oncology in cooperation with the IARC. The calculator takes into account the average cost of treating patients with late-stage NSCLC (IIIb-IV stage) in 2020–2022, which is calculated based on an analysis of the medical records of patients who were treated in the Department of Medical Cancer Therapy No. 3 of the of the Federal State Budgetary Institution «N. N. Blokhin National Medical Research Center of Oncology» (Head K. K. Laktionov), statistical data on incidence and mortality from NSCLC in Russia, the Gross Domestic Product (GDP) per capita indicator, and the MINEC Forecast of socio-economic development of the Russian Federation for 2023, 2024 and 2025. Results. Stopping smoking after diagnosis of NSCLC stage I–IIIa results in cost savings due to a reduced likelihood of relapses and an increased number of patients who avoid relapses when quitting smoking. Taking into account the fact that the average cost of treatment for patients with stage IIIb–IV NSCLC is 4,000,000 rubles, savings on treatment due to a decrease in the likelihood of relapses and as a result of an increase in the number of relapse-free patients who quit smoking amounted to 3,321 million rubles. and 9,251 million rubles, respectively, per year. Thus, the total cost savings on treatment will amount to 12,588 million rubles or slightly more than 2.3 million rubles per patient who quit smoking. The second source of saving is maintaining the economically active potential of some patients diagnosed with stage I–IIIa NSCLC, due to increased progression free survival as a result of smoking cessation аmounts to 3 304 million rubles per year in terms of per capita GDP. If 100 % of patients with stage I–IIIa NLCLC hypothetically quit smoking, the potential budget savings could reach a significantly greater value of 29,480 million rubles per year. The economic benefit to society in the total metric of per capita GDP, obtained as a result of increased survival and possible preservation of labor activity, could exceed 14 billion rubles over a 5-year period. Conclusion. Smoking cessation in cancer patients is accompanied not only by clinical benefits, i. e. it reduces mortality and improves survival rates, but also by economic benefits for the healthcare system and the country as a whole.

Cardiogenic shock in general intensive care unit: a nationwide prospective analysis of epidemiology and outcome

Abstract Aims Cardiogenic shock (CS) is a life-threatening disease burdened by a mortality up to 50%. The epidemiology has changed with non-ischaemic aetiologies being predominant, although data were mainly derived from patients admitted to dedicated acute cardiac care. We report the epidemiology and outcome of patients with CS admitted to general intensive care unit (ICU). Methods and results Prospective multicentric epidemiological study including 314 general ICU adhering to the GiViTI nationwide registry from 2011 to 2018, excluding cardiac arrest. The primary endpoint of the study was mortality. The association between clinical factors and mortality was evaluated using a logistic regression model. The odds ratios (ORs) of the covariates quantify their association with mortality during hospitalization. A total of 11 052 patients admitted to general ICU {incidence 2.17%; median age 72 [interquartile range (66–81)], 38.7% were women} with CS were included. Forty-seven per cent of patients had more than three organ insufficiency at the time of admission. The most common CS aetiologies were left heart failure (LHF, 5247—47.5%); acute myocardial infarction (3612—32.6%); right heart failure (RHF, 515—4.6%); and biventricular failure (532—4.8%). A total of 85.5% were mechanically ventilated during the ICU hospitalization. The overall ICU mortality was 44.8%, increasing to 53.4% during the hospitalization in the index hospital and to 54.3% at the latest hospital. Right heart failure–cardiogenic shock patients exhibited the highest mortality risk [OR: 1.19, 95% confidence interval (CI) (0.94–1.50); P < 0.001], followed by biventricular CS [OR 1.04, 95% CI (0.82–1.32)]. Respiratory failure [OR 1.13 (95% CI 1.08–1.19)], coagulation disorder [1.17 (95% CI 1.1–1.24)], renal dysfunction [OR 1.55 (95% CI 1.50–1.61)], and neurological alteration [OR 1.45 (95% CI 1.39–1.50)] were associated with worsen outcome along with severe hypotension [systolic blood pressure < 70 mmHg—OR 2.35, 95% CI (2.06–2.67)], increasing age [OR 2.21 95% CI (2.01–2.42)], and longer ICU stay prior to admission (two-fold increase for each 4.7 days). Conclusion In the general ICU, the aetiology of CS, excluding cardiac arrest, remains characterized mostly by LHF with RHF–CS burdened by higher mortality. Multiorgan failure at admission and longer hospital stay before ICU admission predispose to worsen outcome.

Predictors of inadequate gestational weight gain according to iom recommendations and intergrowth-21st standards: the araraquara cohort study

BackgroundGestational weight gain (GWG) is a critical factor for maternal and fetal health.ObjectiveTo identify maternal predictors of inadequate GWG according to the 2009 Institute of Medicine (IOM) recommendations and Intergrowth-21st standards.MethodsA prospective epidemiological cohort study conducted from 2017 to 2023 in southeastern Brazil assessed 1,557 women at three different stages of pregnancy (≤ 18, 20–26, and 30–36 weeks of gestation) and at delivery. Sociodemographic, obstetric, lifestyle, nutritional, and maternal morbidity characteristics were collected, along with biochemical parameters.ResultsAmong the participants, 38.7% had GWG above IOM recommendations, while 67.5% had GWG above the Intergrowth-21st standards. Multinomial logistic regression analysis showed that women with pre-pregnancy obesity and women with the highest body fat percentage had, respectively, a 95% (OR = 1.95; 95% CI: 1.08–3.51) and 1% (OR = 1.01; 95% CI: 1.01–1.05) higher chance of GWG above IOM recommendations. Pregnant women in the lowest tertile of height, smokers, number of previous pregnancies, and women living in crowded homes had, respectively, a 57% (OR = 0.57; 95% CI: 0.41–0.80), 36% (OR = 0.64; 95% CI: 0.37–0.86), 35% (OR = 0.65; 95% CI: 0.43–0.97), and 14% (OR = 0.86; 95% CI: 0.59–0.86) lower chance of GWG above IOM recommendations. Women with diabetes were 2.53 times more likely (OR = 2.53; 95% CI: 1.32–4.83) to have GWG below IOM recommendations. Using the Intergrowth-21st standards, women with the highest body fat percentage had a 12% (OR = 1.12; 95% CI: 1.02–1.24) higher chance of GWG above the 90th percentile. Pregnant women in the lowest tertile of height were 2.82 times more likely (OR = 2.82; 95% CI: 1.08–8.13) and women with the lowest hemoglobin concentrations had a 41% lower chance (OR = 0.59; 95% CI: 0.39–0.88) of having GWG below the 10th percentile. While both guidelines identified body fat percentage and pre-pregnancy obesity as significant predictors of excessive GWG, the Intergrowth-21st standards captured a higher percentage of women exceeding GWG limits.ConclusionThe findings underscore the importance of comparing two instruments for assessing the adequacy of GWG. The IOM and Intergrowth-21st standards provide complementary insights, which can help implement targeted interventions for specific groups of women based on their nutritional and socioeconomic status, lifestyle, and obstetric factors to prevent pregnancy-related complications.

Transmission of tuberculosis in rural Henan, China: a prospective population-based genomic spatial epidemiological study

ABSTRACT The incidence of tuberculosis (TB) has declined more slowly in rural than urban areas in China, and data on the patterns of transmission and the high-risk populations in rural areas remains scarce. We conducted a population-based study of culture-positive pulmonary TB patients diagnosed in rural Linzhou City, Henan Province from July 2018 to February 2023. Genomic clusters were defined based on whole-genome sequencing and risk factors for clustering were identified by logistic regression. Transmission events were inferred with phybreak and transmission links were sought through epidemiological investigation of clustered patients. Logistic regression was used to explore the relationship between genomic differences of patient isolates and geographical distances of patient residences. Spatial hotspots were defined using kernel density estimation. Of 455 culture-positive patients, 430 were included in the final analysis. Overall, 192 (44.7%,192/430) patients were grouped into 49 clusters. Clusters containing ≥5 patients accounted for 18.4% (9/49) of the clusters and clustering was highest in student patients. No super-spreaders were detected. Confirmed epidemiologic links were identified for only 18.2% of clustered patients. The clustering risk decreased rapidly with increasing distances between patient residences, but 77.6% of clustered patient pairs lived ≥5.0 km apart. Both the Central Subdistrict and Rencun Township were identified as hotspots for TB transmission. Recent transmission appears to be an important driver of the TB burden in Linzhou. The formulation of effective strategies to reduce TB incidence in rural areas will require further studies to identify high-risk populations and venues where local inhabitants congregate and transmit the infection.

A prospective epidemiologic study of injuries and illnesses in the football matches of the 14th National Student Games of China

ABSTRACT The aim of this study is to determine the incidence and characteristics of football player injuries and illnesses during the 14th National Student Games of China. The results indicate that 32 illnesses were reported, with 17 (53%) involving the gastrointestinal system, primarily caused by environmental factors (24, 69%). The illness incidence rate was 4.3 cases per 100 players or 10.2 cases per 1,000 player-days. Regarding injuries, 122 cases were reported, yielding an overall injury incidence rate was 38.9 per 1,000 game hours, or 1.14 per game. Most injuries resulted from collisions with other players, occurring predominantly 15 minutes before the end of the first half, and 30 minutes before the end of the game. Most of the injuries were in the ankle, thigh, knee joint, and groin. In conclusion, the injury incidence of football players in the 14th National Student Games of China is high, occurring from a variety of mechanisms. Physical contact should be emphasized during training, core strength, and stability training should be enhanced alongside comprehensive injury management and prevention strategies.

Sport-related concussion in Brazilian professional soccer: A four-year prospective epidemiological analysis

This study aimed to investigate the incidence and other significant features of craniomaxillofacial trauma (CMFT), particularly Sport-Related Concussion (SRC), among professional soccer players from two major leagues in Brazil. This is a prospective epidemiological study which assessed two divisions of the national championship and large regional one over four seasons. Data were gathered from soccer clubs and their medical staff using two online forms. Data related to players (age and position) and injuries (diagnosis, type, body location, laterality, field location, tests performed, need for surgery, time lost in sports, and recurrence) were collected. Between 2016 and 2019, a total of 15 seasons, comprising 3 828 matches and 126 ​324 hours (h) of gameplay, were analyzed. A total of 299 CMFT cases were reported, with a median incidence of 2.37 per 1 000 ​h of play. Among them, there were 178 head and 121 face traumas, which led to 87 SRC (representing 29.10% of all CMFT), with an incidence of 0.69. Defensive midfielders (14.43%) and goalkeepers (14.00%) had the highest prevalence rates of CMFT. Only 3.68% of the injuries, mostly lacerations and fractures, required surgical treatment. This study identified that the average time lost in sports due to SRC was 5.12 days, with a recurrence rate of 12.71%. SRC are a frequent consequence of CMFT in Brazilian professional soccer. Although most cases are mild, there is a high recurrence rate, which may have long-term implications.

Time to level the playing field between men and women — Given similar injury incidence: A two-season analysis of match injuries in elite men and women's (Super League) rugby league

ObjectivesTo compare match injury incidence, severity and burden in men's and women's elite rugby league. DesignA prospective cohort epidemiological study. MethodsTime loss match injury data were collected from all men's (11,301 exposure hours) and women's (5,244 exposure hours) Super League clubs. ResultsInjury incidence and burden were not different between men and women (mean [95 % CI]; 54 [45 to 65] vs. 60 [49 to 74] per 1000 match-hours; p = 0.39, and 2332 [1844 to 2951] vs. 1951 [1560 to 2440] days lost per 1000 match-hours; p = 0.26). However, injury severity was greater for men than women (42 [35–50] vs. 35 [29 to 42]; p = 0.01). Lower limbs accounted for 54 % and 52 % of injuries for men and women, with the head/face the most frequently injured location due to concussion (12 [10 to 15] and 10 [8 to 14] per 1000 match-hours for men and women). Injuries to the knee had the greatest burden for men and women (708 [268–1868] and 863 [320–2328] days lost per 1000 match-hours). Being tackled was the most common injury mechanism for men and women (28 % and 38 %) with greater burden (p < 0.01) than other injury mechanisms. ConclusionsMale and female rugby league players have similar injury incidence and burden; however, injury severity was higher in men. Head/face injuries have the highest injury incidence and knee injuries have the highest burden. These injuries should be the focus for prevention initiatives at a league (via laws), player, and coach level, with equal and specific focus for both men's and women's rugby league players.

Implementation of the WHO Tricycle protocol for surveillance of extended-spectrum β-lactamase producing Escherichia coli in humans, chickens, and the environment in Madagascar: a prospective genomic epidemiology study

Antimicrobial resistance (AMR) is a major public health threat, affecting not only people but also animals and the environment. The One Health dimension of AMR is well known; however, data are lacking on the circulation of resistance-conferring genes, particularly in low-income countries. In 2017, WHO proposed a protocol called Tricycle, focusing on extended-spectrum β-lactamase (ESBL)-Escherichia coli surveillance in the three sectors (humans, animals, and the environment). We implemented Tricycle in Madagascar to assess ESBL-E coli prevalence and describe intrasector and intersector circulation of ESBL-E coli and plasmids. In this prospective study, we collected blood culture data from hospitalised patients with a suspected bloodstream infection processed from May 1, 2018, to April 30, 2019, and rectal swabs from healthy pregnant women from July 30, 2018, to April 27, 2019, both from three hospitals in Antananarivo, Madagascar; and caeca from farm chickens and surface waters from the Ikopa river, wastewater, and slaughterhouse effluents in the Antananarivo area, Madagascar, from April 9, 2018, to April 30, 2019. All samples were tested for ESBL-E coli. The genomes of all isolates were sequenced using a short-read method on NextSeq 500 and NovaSeq 6000 platforms (Illumina, San Diego, CA, USA) and those carrying plasmid replicons using an additional long-read method on a MinION platform (Oxford Nanopore Technologies, Oxford, UK). We characterised genomes of isolated strains (sequence type, resistance and virulence gene content, and plasmid replicons). We then compared isolates using the variant calling method (single-nucleotide polymorphism). Data from 1056 blood cultures were collected and 289 pregnant women, 246 chickens, and 28 surface waters were sampled. Of the blood cultures, 18 contained E coli, of which seven (39%) were ESBL. ESBL-E coli was present in samples from 86 (30%) of 289 pregnant women, 140 (57%) of 246 chickens, and 28 (100%) of 28 surface water samples. The wet season (November to April) was associated with higher rates of carriage in humans (odds ratio 3·08[1·81-5·27]) and chickens (2·79 [1·65-4·81]). Sequencing of 277 non-duplicated isolates (82 from pregnant women, 118from chickens, and 77 from environmental samples) showed high genetic diversity (90 sequence types identified) with sector-specific genomic features. Single nucleotide polymorphism (SNP) analysis revealed that 169(61%) of 277 isolates grouped into 44 clusters (two or more isolates) of closely related isolates (<40 SNPs), of which 24 clusters contained isolates from two sectors and five contained isolates from all three sectors. ESBL genes were all blaCTX-M variants (215 [78%] of 277 being blaCTX-M-15) and were located on a plasmid in 113 (41%) of 277isolates. These ESBL-carrying plasmids were mainly IncF (63 [55%] of 114; one strain carried two plasmids) and IncY (42 [37%] of 114). The F31/36:A4:B1 (n=13) and F-:A-:B53 (n=8) pMLST subtypes, and the IncY plasmids, which were all highly conserved, were observed in isolates of differing genetic backgrounds from all sectors and were transferable invitro by conjugation. Despite sector-specific population structures, both ESBL-E coli strains and plasmids are circulating among humans, chickens, and the environment in Antananarivo, Madagascar. The Tricycle protocol can be implemented in a low-income country and represents a powerful tool for investigating dissemination of AMR from a One Health perspective. Fondation Mérieux and INSERM, Université Paris Cité.

Comparison of Magnetic Resonance Imaging with Electrodiagnosis in the Evaluation of Clinical Suspicion of Lumbosacral Radiculopathy.

(1) Background: The diagnosis of lumbosacral radiculopathy involves anamnesis, an assessment of sensitivity and strength, diagnostic imaging-usually magnetic resonance imaging (MRI)-and electrodiagnostic testing (EDX), typically electromyography (EMG), and electroneurography (ENG). MRI evaluates the structures supporting the spinal cord, while EDX evaluates root functionality. The present study aimed to analyze the concordance of MRI and EDX findings in patients with clinically suspected radiculopathy. Additionally, we investigated the comparison between these two reference tests and various clinical variables and questionnaires. (2) Methods: We designed a prospective epidemiological study of consecutive cases with an observational, descriptive, cross-sectional, and double-blind nature following the STROBE guidelines, encompassing 142 patients with clinical suspicion of lumbosacral radiculopathy. (3) Results: Of the sample, 58.5% tested positive for radiculopathy using EDX as the reference test, while 45.8% tested positive using MRI. The comparison between MRI and EDX in the diagnosis of radiculopathy in patients with clinical suspicion was not significant; the overall agreement was 40.8%. Only the years with symptoms were comparatively significant between the positive and negative radiculopathy groups as determined by EDX. (4) Conclusion: The comparison between lumbar radiculopathy diagnoses in patients with clinically suspected pathology using MRI and EDX as diagnostic modalities did not yield statistically significant findings. MRI and EDX are complementary tests assessing different aspects in patients with suspected radiculopathy; degeneration of the structures supporting the spinal cord does not necessarily imply root dysfunction.

Dental treatments under sedation-analgesia in patients who are unable to collaborate: a prospective observational study.

Excessive fear of dental procedures leads to disruptive behavior during dental examinations and treatments. Dental examinations and treatments of these patients usually require additional techniques, such as sedation. The most commonly used techniques are inhalation of nitrous oxide, infusion of propofol with fentanyl, and premedication and infusion of midazolam. A prospective observational epidemiological study was conducted on patients who required sedoanalgesia techniques for dental exploration and procedures. The reasons for the inability of patients to cooperate (excessive fear or intellectual disability), age, sex, weight, systemic pathology, oral pathology, treatment performed, time of intervention, anesthetic technique performed, and occurrence of complications were recorded. In total, 218 patients were studied. Sixty-five patients came for fear of dental treatment and 153 for presenting with a diagnosis of intellectual disability and not collaborating in the treatment with local anesthesia. The average age of all patients was 30.54 ± 17.30 years. The most frequent oral pathologies found in patients with excessive fear were tartar (6.8%) and wisdom teeth (6.4%), followed by missing teeth (5%). In patients with disabilities, a combination of tartar and cavities appeared most frequently (41.3%), followed by cavities (15.6%). The most frequently used sedoanalgesia technique was the infusion of propofol with fentanyl in both groups of patients, followed by nitrous oxide. The combination of propofol and fentanyl was the most frequently used alternative in patients who were unable to collaborate because of intellectual disability or carry out longer or more complex treatments. Inhaled nitrous oxide and midazolam were the sedative techniques of choice for simpler oral treatments, such as tartrectomies, shallow obturations, and shorter interventions, or in younger patients.

Cardiogenic shock in general intensive care unit: a nationwide prospective analysis of epidemiology and outcome

Abstract Funding Acknowledgements None. Background Cardiogenic shock (CS) is a heterogenous, life-threatening disease burdened by a mortality up to 50%. An increasing incidence of the CS related to other etiological causes, including acute decompensated heart failure, has been reported. However, most of the epidemiological data are derived from patients admitted to dedicated acute cardiac care units. Epidemiology and management of CS patients admitted to general intensive care unit (ICU) in Italy is yet unexplored. Purpose To describe the epidemiology, patients feature, management and outcome of CS patients admitted to Italian general ICUs. Methods Prospective multicentric epidemiological study. Over 600 thousand patients admitted to 316 hundred Italian general intensive care units from 2011 to 2018 were screened trough PROSAFE software. The Margherita PROSAFE project is an observational project for the continuous electronic collection of data on patients admitted to ICUs; it is developed by the GiViTI (Gruppo italiano per la valutazione degli interventi in terapia intensiva - Italian Group for the Evaluation of Interventions in Intensive Care Medicine). The primary outcome of the analysis was hospital mortality. Secondary outcomes included description of patients features and management. Results 11661 patients (72.1±12.1 years old.; 39.5% women) with a diagnosis of CS were included in the analysis. ICU and in-hospital mortality were respectively 45.5 % and 53.9%. Highest mortality was observed for pulmonary embolism (58.4%), right heart failure (56.3%) and acute decompensated heart failure (ADHF) (44.2%). 46.9% of patients presented with more than 3 organ failure (panel A). CS commonest aetiologies were ADHF (63,3%), acute myocardial infarction (19.8%) and right heart failure (11%). Invasive mechanical ventilation was used in the 88.6% of cases. Intra-aortic balloon pump was placed in 15.2%, with higher frequency in ischemic aetiologies (43.9%) and ADHF (13.7%); VA-ECMO was most frequently placed in the right heart failure (3.7%) and acute myocardial infarction (2.6%) groups. The factors independently associated with increased hospital mortality were increasing age (p &amp;lt;0.001), lower Glasgow coma scale (p &amp;lt;0.001), hypoxemia (PaO2 &amp;lt;100, OR: 1.91; 95% Cl: 1.58 – 2.3; p &amp;lt;0.001), bradycardia (OR: 1.84; 95% Cl: 1.49 – 2.26; p &amp;lt;0.001), hypotension (OR: 1.27; 95% Cl: 1.12 – 1.43; p &amp;lt;0.001), bilirubin above 12 mg/dl (OR: 7.90; 95% Cl: 2.56 – 24.3), increased creatinine (p &amp;lt;0.001) and reduced platelets (&amp;lt;50000 U/mL, OR: 2.43; 95% Cl: 1.78 – 3.31; p &amp;lt;0.001) (panel B). Curiously, in the predictive model a BMI above normal values was protective as well as tachycardia compared to severe bradycardia (panel C). Conclusions The etiology of CS in general intensive care units is heterogeneous with acute heart failure being the commonest. The mortality rate remains unacceptably high with right heart failure and acute heart failure being burden by the worst outcome.

Prevalence of major adverse cardiovascular events among Saudi patients with systemic lupus erythematosus compared with the general population: updates from the national SLE and PURE cohorts

ObjectiveThis study examined the prevalence of major adverse cardiovascular events (MACE) among Saudi patients with SLE and the general population and considered factors associated with such outcomes were taken into...

Most procedures performed in the intensive care unit are invasive: tracheal intubation, tracheostomy, central catheterization, chest tubes and others. However, they are not without complications that can be life-threatening. The aim of this prospective epidemiological study is to assess the incidence of complications arising from invasive procedures performed in the ICU, and to analyze certain risk factors that expose patients

Most procedures performed in the intensive care unit are invasive: tracheal intubation, tracheostomy, central catheterization, chest tubes and others. However, they are not without complications that can be life-threatening. The aim of this prospective epidemiological study is to assess the incidence of complications arising from invasive procedures performed in the ICU, and to analyze certain risk factors that expose patients to these complications. This was a prospective study of 453 invasive procedures performed in the various intensive care units of Casablanca University Hospital, over a period of 18 months, using 4 data sheets. In our series, central venous catheters accounted for 66% of invasive procedures. The average age of our patients was 40 years, and 67% were male. The main complications associated with the placement of central venous catheters are: Hematoma (16%); pneumothorax (3%), aberrant trajectory (4%) and thrombosis (3%). The incidence of hematoma is 20% when the procedure is performed on-call, and 38.3% when the operator has more than 2 years’ experience. The second most frequently performed invasive procedure is tracheostomy, with a percentage of 16%, which most frequently cited complications are as follows: bleeding (12%), pneumothorax (8%), and subcutaneous emphysema (9%). Statistical analysis showed that there was no correlation between the occurrence of complications and the risk factors studied. Other complications accounted for less than 10%. The outcome of intensive care patients has improved considerably, thanks to the protocols proposed by the various hospitals. Reducing complications is an important objective, in which the importance of learning the procedure and the experience of the operator should figure prominently.

Adherence to the Mediterranean diet and 20-year incidence of hypertension: the ATTICA prospective epidemiological study (2002-2022).

Dietary habits are a significant predictor of hypertension (HTN). We aimed to evaluate the long-term association between adherence to the Mediterranean diet and HTN incidence. This was a prospective study among 1415 non-hypertensive adults (44% men, age: 41 ± 13 years) followed up for 20 years. Anthropometric, lifestyle, and clinical parameters were evaluated at baseline. Adherence to the Mediterranean diet was evaluated both at baseline and 10 years through the MedDietScore (range: 0-55, higher values indicate greater adherence). At the 20-year follow-up, 314 new HTN cases were recorded. HTN incidence was 35.5%, 22.5%, and 8.7% in the lowest, middle, and upper tertile of baseline MedDietScore, respectively (p < 0.001). For each 1-point increase in baseline MedDietScore, the 20-year HTN risk decreased by 7% [relative risk (RR): 0.925, 95% confidence interval (CI): 0.906, 0.943], and this effect remained significant after adjustment for age, sex, and baseline lifestyle and clinical confounders, i.e., body mass index, physical activity, smoking, systolic and diastolic blood pressure, family history of HTN, and presence of hypercholesterolemia and diabetes mellitus (RR: 0.973, 95%CI: 0.949, 0.997). In a similar multiadjusted model, compared to subjects who were consistently away from the Mediterranean diet (in the lowest MedDietScore tertile both at baseline and 10 years), only those who were consistently close (in the middle and upper MedDietScore tertiles both at baseline and 10 years) exhibited a 47% lower 20-year HTN risk. A high adherence to the Mediterranean diet, particularly when longitudinally sustained, is associated with lower incidence of HTN.

Preconceptional micronutrient adequacy among women in Greece: a prospective epidemiological study

Introduction The importance of micronutrient intake during the preconceptional and early pregnancy period for both maternal and fetal outcomes is well-known, however, relevant data are not available for Greek pregnant women. The aim of the present study is to delineate the nutritional status preceding conception among a representative cohort of Greek pregnant women. Methods This was a prospective study of pregnant women from routine care, recruited at 11+0–13+6 gestational weeks, between December 2020 and October 2022, at the 3rd Department of Obstetrics and Gynecology, Aristotle University of Thessaloniki, Greece. Eligible participants for the study included healthy pregnant women aged 20 years or older, possessing a proficient understanding of the Greek language, and not engaged in specific nutritional programs. A validated Food Frequency Questionnaire was applied to gather information regarding nutritional habits in the last 6 months prior to conception. The consumption of nutrients was compared to the reference intake levels suggested by the European Food Safety Authority. Further analyses between different participants’ subgroups were performed. Results Overall, 1100 pregnant women (mean age: 32.4 ± 4.9 years) were enrolled. Almost all examined micronutrients’ intake was significantly different from dietary reference values. Furthermore, nutrient adequacy ratio was below 60% in 6 out of 22 micronutrients examined, and Mean Adequacy Ratio was 93%. However, Mean Adequacy Ratio is characterized by extreme variance between the examined values. Iodine, folic acid, potassium, and vitamin D intake levels were significantly lower than the recommended intake levels (p < .001 for all), while vitamin K and niacin (p < .001 for both) were consumed in great extent. Sodium median intake, without calculating extra salt addition also exceeded the reference value levels (p = .03). Notably, magnesium intake exceeded the upper safety limits in 12.4% of the sample. Conclusion Potential inadequacies in important micronutrients for uneventful pregnancy outcomes have been revealed.. Special attention is needed for magnesium to balance possible toxicity with evident benefits.

GLAUCOMA EPIDEMIOLOGICAL SITUATION IN THE FERGANA VALLEY: REGIONAL CHALLENGES

The aim of the research was to organize and conduct a prospective analytical epidemiological study to determine the prevalence of glaucoma in the Andijan region of the Fergana Valley.

Citrullinated and MMP-degraded vimentin is associated with chronic pulmonary diseases and genetic variants in PADI3/PADI4 and CFH in postmenopausal women

Citrullinated vimentin has been linked to several chronic and autoimmune diseases, but how citrullinated vimentin is associated with disease prevalence and genetic variants in a clinical setting remains unknown. The aim of this study was to obtain a better understanding of the genetic variants and pathologies associated with citrullinated and MMP-degraded vimentin. Patient Registry data, serum samples and genotypes were collected for a total of 4369 Danish post-menopausal women enrolled in the Prospective Epidemiologic and Risk Factor study (PERF). Circulating citrullinated and MMP-degraded vimentin (VICM) was measured. Genome-wide association studies (GWAS) and phenome wide association studies (PheWAS) with levels of VICM were performed. High levels of VICM were significantly associated with the prevalence of chronic pulmonary diseases and death from respiratory and cardiovascular diseases (CVD). GWAS identified 33 single nucleotide polymorphisms (SNPs) with a significant association with VICM. These variants were in the peptidylarginine deiminase 3/4 (PADI3/PADI4) and Complement Factor H (CFH)/KCNT2 gene loci on chromosome 1. Serum levels of VICM, a marker of citrullinated and MMP-degraded vimentin, were associated with chronic pulmonary diseases and genetic variance in PADI3/PADI4 and CFH/ KCNT2. This points to the potential for VICM to be used as an activity marker of both citrullination and inflammation, identifying responders to targeted treatment and patients likely to experience disease progression.

Prospective incidence epidemiology study protocol: conducting active surveillance to assess the burden of Lyme disease (BOLD) in primary care practices in endemic areas of six European countries

IntroductionLyme disease (LD) is the most frequent tick-borne disease in the moderate climates of Europe. This study will inform the phase III efficacy study for Pfizer and Valneva’s investigational Lyme...